Pay Equity Is Health Equity: Compensating People With Lived Experience
Engaging people with lived experience in any project or policy work must be based on time, trust, equal partnership roles… and fair compensation, of course. This last part is often easier said than done, so here are some suggestions on how to go about it.
Imagine your organization wishes to learn from someone with expertise in accessible local transportation. You know it’s an area your org lacks knowledge, and you know your program will be more effective with the consultant’s feedback.
Once the program is mostly developed and close to launch, you present it to the consultant for feedback. In exchange, you offer them a $25 gift card. With the launch deadline approaching, you incorporate one or two relatively simple changes and don’t follow up with the consultant again.
Would your program be improved by that last-minute input? Would you get quality advice with that budget? Would that consultant be excited to work with you again?
This interaction would border on absurd. Yet this is how social service and health organizations tend tostructure their engagement with the people with the most expertise about the subject at hand: those who will be impacted by the program being developed.
Many organizations seek to hold focus groups and listening sessions with their communities. This is a great start. Ultimately, though, if your goals include equity and relationship-building, engagement must go beyond occasional touches taking place at the beginning or end of a project. As examined last month in our blog, engagement with people with lived experience means co-participation throughout the process of program development, implementation, and analysis. This requires mutual trust and respect, which includes fair compensation.
The State of Washington’s Community Compensation Guidelines state:
“…equitable public policy discussions should include individuals directly impacted by that policy. …The legislature finds that asking community members with lower financial means to volunteer their time and expertise while state employees and representatives of advocacy organizations receive compensation from their respective agency or organization for their time and experience ultimately hinders full and open public participation.”
The HUD Exchange states in its COVID-19 homeless system response:
“Creating community models that inclusively acknowledge and value the agency of PLEE [people with current or former lived experience and expertise] across all decision-making aspects is essential, especially as we collectively work to advance equity and inclusion. As this capacity-building work continues in our communities, it is vitally important that PLEE are appropriately compensated for contributing their time, energy, and valuable expertise. Compensation acknowledges and affirms the contributions of PLEE, addresses inequalities between those who are and those who are not paid to engage in the work, and helps break down barriers to participation.”
And the Center for Health Care Strategies says in its recent brief about equitable compensation:
“Equitably compensating community members for their time and expertise shows that your organization values their input similarly to other types of consultants — an internal practice that can amplify your organization’s commitment to equity….
Compensation can attract a more diverse set of community members to participate in community engagement, opening your organization up to new perspectives and populations.”
While compensating community members for their experience is reasonable and just, it is not alwaysstraightforward. The practice takes preparation and patience. Following are some suggestions for getting started.
Determine How Much to Pay
Start with an accounting of how much you offer other contractors for similar types of work. How many people are involved? How long is the engagement? What is the nature of the tasks you are asking folks to do? Arethere different levels and types of engagement that require different pay tiers? Follow the same process you would for any other contractor in order to develop a community-member compensation structure.
If offering compensation in line with other partners and advisors feels unreachable at this time, offer at minimum a living wage (or its project-based equivalent) for your area. Then start planning to restructure your organization’s functions and funding to bring more equity to your compensation practices (more on this step further down the page).
Compensation for community voice requires some important and unique considerations. People may be reluctant or unable to participate if they have concerns about childcare, transportation, work schedules, or other challenges. Make sure to listen and learn from your community what supports and resources are needed in order for them to come to the table worry-free. You can learn from your community when, where, and how to communicate and meet to make the program work best for them. If possible, don’t consider these elements to be substitutes for paid compensation, but rather essentials for a welcoming meeting space that conveys your authentic interest and gratitude.
You may find that some people do not wish to be compensated financially. This might be because they see their work as a volunteer service, they are uncomfortable with the payment type or requirements, or some other reason. There is no reason to oblige people to take payment, but you always want to offer it.
Determine How to Pay
You might choose an hourly wage or a stipend; you might pay by check, cash, debit or gift card, direct transfer, or some other form. Compensation can also look like needed items for daily living, such as a bicycle, car seat, or job skills training. Here are some considerations to keep in mind:
Paperwork can invoke hesitancy or discomfort for people who have had negative experiences with bureaucratic agencies such as for criminal justice or homeland security. And accounting and reporting requirements can be extremely time-consuming for your organization, as well. Many organizations have found that offering stipends by project as opposed to hourly wages eases the reporting and accounting burdens considerably.
Cash quickly gets difficult for organizations to manage and track. Checks can present barriers related to bank account access, documentation, and mailing addresses. Many organizations have found gift cards to be the best option for everyone. Note that technically gift cards are considered income.
Forms of compensation can best be determined by discussing the policy in partnership with the community members themselves. You may find that different forms work for different people, based on their specific contexts and situations.
Consider engaging the people themselves in the discussion around how much to pay them as well as how to pay them. Be aware that community members may not necessarily be used to being asked for this type of input and may be surprised or uncertain how to respond. If you choose to engage this question, you will want to approach it as an ongoing conversation as opposed to a one-time Q&A session.
Prepare for Support and Training—for All Involved
Payment to someone who is receiving federal or state benefits, including in the form of gift cards, can endanger their eligibility status for those benefits. Until these counterproductive policies can be changed, you will want to make absolutely sure community members and staff understand this possibility and how it can be avoided. For example, many organizations split compensation into monthly chunks, and/or across calendar years. This Camden Coalition publication has additional helpful information and ideas.
No matter how seamless you strive to make the payment process, recipients may find they need to complete unfamiliar tax filings and other administrative work, including facing potential consequences for errors. In your planning, build in time and resources for training and support as needed.
It can feel intimidating to start the process, but you can keep things lower stakes by taking one step at a time, applying learnings as you go. Work with participants on dividing up the project and planning for stipends by portion. This works for everyone, because community members may not want to participate in every step, and your organization may have needs for different types of participation at different steps. Portioning the work allows for the natural ebb and flow of availability and interest, and it allows your organization the flexibility to adjust the amount and type of engagement over time.
Three Words: Relationship, Relationship, Relationship
Even in matters of compensation policies, relationships mean everything. Simply put, offering payment will not yield the recruitment, participation, or effectiveness you are hoping for unless community members alsofeel safe and respected.
If, say, a hospital has few community partners, does scant community support work, and hires from outside the community, an informational session or event in the hospital boardroom will not yield the hoped-for results. Arrange your schedules, materials, and resources to literally meet the community where they are; leave your building and go to where the population you wish to serve regularly goes.
On the other hand, descending on a beloved community locale uninvited is also not recommended. What to do?
Forge the relationships first, before asking for information or participation, and before asking for space. If you are a backbone organization or other larger organization, connect with smaller organizations that know the community. Recognize that you are the ones who need help and expertise, and listen to the concerns, pleasures, needs, and viewpoints of the people who hold that expertise.
Learn from Models and Frameworks
Washington State’s community compensation guidance is an incredible example of a very largegovernmental organization making the structural and philosophical changes needed to authentically welcome, validate, and institutionalize the input of people with lived experience.
Washington sourced a coalition of economic-justice organizations with a history of justice initiatives to lead the process of gathering input about the project from communities throughout the state. The state then listened, trusted, and applied.
One result of this process is the establishment of community assemblies, which now regularly participate in the Washington State governing process. Another result is the completion of thorough, detailed, and actionable guidelines for community compensation. If you are interested in creating your own framework and guidelines, take a look at this excellent resource.
The HUD Exchange offers a succinct yet powerful brief with rationales and tips for compensation. The Center for Health Care Strategies also offers a thorough and methodical guide to equitable compensation. And the Camden Coalition’s brief on equitable compensation and the benefits cliff is full of helpful information and recommendations. These short, accessible guides make for some great reading.
Accept, and Offer, Support for Structural Change
It’s essential to factor in the cost of compensation for community members when you are doing your financial and program planning, just as you would with vendors, contractors, experts, and other essential external program personnel. Beware of delaying with the intention of squeezing funds out of existing resources or submitting for another pool of money later. This practice will invite all manner of administrative and ethical burdens.
Organizations that successfully and sustainably compensate people with lived experience must often firstundergo deep internal reflection and restructuring. Washington State changed its policy-making process to authentically integrate the voices of the people, especially people who have been systematically marginalized. WNC Health Network has been sharing in our Incubator peer-to-peer meetings how they reorganized their budgeting process to be transparent, participatory, and co-led by teams of people affected by the budget. Organizations can also think critically about who their vendors are and who they employ, with the goal of changing these patterns to be more in line with their community and their values.
Patience—and Persistence
No matter how thoughtful and informed your restructuring may be, the fact is that granting organizations may not necessarily be there yet. It can be difficult to locate funds that cover the sorts of operational costs needed for systems-changing equity work, on the sorts of timelines that are realistic.
Difficult—but not impossible. DASH’s Incubator seeks to change the power dynamic between organizations and funders by co-designing the program itself with awardees and by supporting awardees in their equity work through unrestricted funds, flexibility, and longer timelines. In turn, DASH’s work would not be possible without the Robert Wood Johnson Foundation’s wider commitment to equity inroads.
Organizations are not powerless, either. When strong and knowledgeable equity practices are embraced by staff, staff effectively conveys the imperative to their boards; from there, the message and the methods do tend to spread.
Making a change in compensation can feel overwhelming. The good news is that there are multiple models, frameworks, and entry points to start such as those linked in this post. And change really does start from within: the equity work you have done (or plan to do) inside your organization will illuminate the best next steps for you.